MEDICARE: JACQUELINE RISLEY REECE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1063735173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE RISLEY REECE

Provider Business Mailing Address
First Line	:	13139 W LINEBAUGH AVE
Second Line	:	UNIT 201
City	:	TAMPA
State	:	FL
Zip	:	33626-4498
Country	:	US
Telephone Number	:	813-932-3013
Fax Number	:	813-932-3016

Provider Business Practice Location Address
First Line	:	13139 W LINEBAUGH AVE
Second Line	:	UNIT 201
City	:	TAMPA
State	:	FL
Zip	:	33626-4498
Country	:	US
Telephone Number	:	813-932-3013
Fax Number	:	813-932-3016

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2010
Last Update Date	:	03/03/2010

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Practice Location Address:

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Practice Location Address:

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1356570097 — MS. SYLVIA JUANITA TURNER
Practice Location Address:

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33626-4498

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Practice Location Address:

13139 W LINEBAUGH AVE , SUITE 201
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Practice Location Address:

13139 W LINEBAUGH AVE , #201
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